Heart Rhythm
Volume 6, Issue 12, Supplement , Pages S50-S63 , December 2009

Linear left atrial lesions in minimally invasive surgical ablation of persistent atrial fibrillation: Techniques for assessing conduction block across surgical lesions

  • Deborah Lockwood, BM, BCh, MA

      Affiliations

    • Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
    • Corresponding Author InformationAddress reprint requests and correspondence: Deborah Lockwood, B.M., B.Ch., M.A., Heart Rhythm Institute, University of Oklahoma Health Sciences Center, 1200 Everett Drive (TUH-6E-103), Oklahoma City, Oklahoma 73104
    • ,
  • Hiroshi Nakagawa, MD, PhD

      Affiliations

    • Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
    • ,
  • Marvin D. Peyton, MD

      Affiliations

    • Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
    • ,
  • James R. Edgerton, MD

      Affiliations

    • Heart Hospital, Plano, Texas
    • ,
  • Benjamin J. Scherlag, PhD

      Affiliations

    • Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
    • ,
  • Chittur A. Sivaram, MD

      Affiliations

    • Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
    • ,
  • Sunny S. Po, MD, PhD

      Affiliations

    • Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
    • ,
  • Karen J. Beckman, MD

      Affiliations

    • Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
    • ,
  • Moeen Abedin, MD

      Affiliations

    • Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
    • ,
  • Warren M. Jackman, MD

      Affiliations

    • Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma

References 

  1. Haissaguerre M, Hocini M, Sanders P, et al. Catheter ablation of long-lasting persistent atrial fibrillation: clinical outcome and mechanisms of subsequent arrhythmias. J Cardiovasc Electrophysiol. 2005;16:1138–1147
  2. Cheema A, Dong J, Dalal D, et al. Long-term safety and efficacy of circumferential ablation with pulmonary vein isolation. J Cardiovasc Electrophysiol. 2006;17:1080–1085
  3. Elayi CS, Verma A, Di Biase L, et al. Ablation for longstanding permanent atrial fibrillation: results from a randomized study comparing three different strategies. Heart Rhythm. 2008;5:1658–1664
  4. Gaynor SL, Ishii Y, Diodato MD, et al. Successful performance of Cox-maze procedure on beating heart using bipolar radiofrequency ablation: a feasibility study in animals. Ann Thorac Surg. 2004;78:1671–1677
  5. Prasad SM, Maniar HS, Schuessler RB, Damiano RJ. Chronic transmural atrial ablation by using bipolar radiofrequency energy on the beating heart. J Thorac Cardiovasc Surg. 2002;124:708–713
  6. Gaynor SL, Diodato MD, Prasad SM, et al. A prospective, single-center clinical trial of modified Cox maze procedure with bipolar radiofrequency ablation. J Thorac Cardiovasc Surg. 2004;128:535–542
  7. Yilmaz A, Van Putte BP, Van Boven WJ. Completely thoracoscopic bilateral pulmonary vein isolation and left atrial appendage exclusion for atrial fibrillation. J Thorac Cardiovasc Surg. 2008;136:521–522
  8. Edgerton JR, Jackman WM, Mack MJ. A new epicardial lesion set for minimal access left atrial maze: the Dallas lesion set. Ann Thorac Surg. 2009;88:1655–1657
  9. Edgerton JR, Jackman WM, Mahoney C, Mack MJ. Totally thorascopic surgical ablation of persistent and long-standing persistent atrial fibrillation using the “Dallas Lesion Set.”. Heart Rhythm. 2009;6:S64–S70
  10. Schauerte P, Scherlag BJ, Patterson E, et al. Focal atrial fibrillation: experimental evidence for a pathophysiologic role of the autonomic nervous system. J Cardiovasc Electrophysiol. 2001;12:592–599
  11. Nakagawa H, Scherlag BJ, Patterson E, et al. Pathophysiologic basis of autonomic ganglionated plexi ablation in patients with atrial fibrillation. Heart Rhythm. 2009;S26–S34
  12. Po SS, Nakagawa H, Jackman WM. Localization of left atrial ganglionated plexi in patients with atrial fibrillation. J Cardiovasc Electrophysiol. 2009;20:1186–1189
  13. Lu Z, Scherlag BJ, Lin J, et al. Atrial fibrillation begets atrial fibrillation: autonomic mechanism for atrial electrical remodeling induced by short-term rapid atrial pacing. Circ Arrhythm Electrophysiol. 2008;1:184–192
  14. Haissaguerre M, Jais P, Dipen C, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med. 1998;339:659–666
  15. Veenhuyzen GD, Knecht S, O'Neill MD, et al. Atrial tachycardias encountered during and after catheter ablation for atrial fibrillation. PACE. 2009;32:393–398
  16. Gerstenfeld EP, Callans DJ, Dixit S, et al. Mechanisms of organized left atrial tachycardias occurring after pulmonary vein isolation. Circulation. 2004;110:1351–1357
  17. Cox JL, Ad N. The importance of cryoablation of the coronary sinus during the maze procedure. Semin Thorac Cardiovasc Surg. 2000;12:20–24
  18. Knecht S, Hocini MWright, et al. Left atrial linear lesions are required for successful treatment of persistent atrial fibrillation. Eur Heart J. 2008;29:2359–2366
  19. Nakagawa H, Yokoyama K, Katari V, et al. Characterization of left atrial tachycardia after ganglionated plexi ablation plus pulmonary vein antrum isolation. Heart Rhythm. 2007;4:S311;(abstract)
  20. Nakagawa H, Shah N, Matsudaira K, et al. Characterization of reentrant circuit in macroreentrant right atrial tachycardia after surgical repair of congenital heart disease: isolated channels between dense scars allow “focal” ablation. Circulation. 2001;103:699–709
  21. Nakagawa H, Jackman WM, Yokoyama K, et al. Catheter ablation of macroreentrant right and left atrial tachycardias. In:  Wilber DJ,  Packer DL,  Stevenson WG editor. Catheter Ablation of Cardiac Arrhythmias: Basic Concepts and Clinical Applications. 3d ed.. Blackwell Futura; 2008;p. 192–217
  22. Edgerton JR, Jackman WM, Mack MJ. Minimally invasive pulmonary vein isolation and partial autonomic denervation for surgical treatment of atrial fibrillation. J Interv Electrophysiol. 2007;20:89–93
  23. Edgerton JR, Edgerton ZJ, Weaver T, et al. Minimally invasive pulmonary vein isolation and partial autonomic denervation for surgical treatment of atrial fibrillation. Ann Thorac Surg. 2008;86:35–38
  24. Edgerton JR, McClelland JH, Duke D, et al. Minimally invasive surgical ablation of atrial fibrillation: six-month results. J Thorac Cardiovasc Surg. 2009;138:109–114
  25. Beyer E, Lee R, Lam BK. Minimally invasive bipolar radiofrequency ablation of lone atrial fibrillation: early multicenter results. J Thorac Cardiovasc Surg. 2009;137:521–526
  26. Bagge L, Blomström P, Nilsson L, Einarsson GM, Jideus L, Blomstrom-Lundqvist C. Epicardial off-pump pulmonary vein isolation and vagal denervation improve long-term outcome and quality of life in patients with atrial fibrillation. J Thorac Cardiovasc Surg. 2009;137:1265–1271
  27. Cox JL, Schuessler RB, D'Agostino HJ, et al. The surgical treatment of atrial fibrillation (III. Development of a definitive surgical procedure). J Thorac Cardiovasc Surg. 1991;101:569–583
  28. Hocini M, Jais P, Sanders P, et al. Techniques, evaluation, and consequences of linear block at the left atrial roof in paroxysmal atrial fibrillation. Circulation. 2005;112:3688–3696
  29. Barry A, Patten BM. The structure of the adult heart. In:  Gould SE editors. Pathology of the Heart and Blood Vessels. 3rd ed.. Springfield, Illinois: Charles C. Thomas Publishers; 1968;p. 91–130
  30. Jais P, Hocini M, Hsu LF, et al. Technique and results of linear ablation at the mitral isthmus. Circulation. 2004;110:2996–3002
  31. Tang K, Ma J, Zhang S, et al. Radiofrequency catheter ablation at the left coronary cusp in treatment of repetitive monomorphic tachycardia of the left ventricular outflow tract. Chin Med J. 2004;117:168–171
  32. Lamberti F, Calo L, Pandozi C, et al. Radiofrequency catheter ablation of idiopathic left ventricular outflow tract tachycardia: utility of intracardiac echocardiography. J Cardiovasc Electrophysiol. 2001;12:529–535
  33. Ikeda A, Nakagawa H, Martin KE, Pitha JV, Sharma T, Jackman WM. Lesion transmurality for surgical epicardial linear ablation can be predicted by electrogram amplitude reduction and double potentials. Circulation. 2008;118:S831;(abstract)
  34. Thomas SP, Guy DJR, Boyd AC, Eipper VE, Ross DL, Chard RB. Comparison of epicardial and endocardial linear ablation using handheld probes. Ann Thorac Surg. 2003;75:543–548
  35. Lustgarten DL, Bell S, Hardin N, Calame J, Spector PS. Safety and efficacy of epicardial cryoablation in a canine model. Heart Rhythm. 2005;2:82–90
  36. Wood M, Ellenbogen A, Pathak V, Kasarajan V. Efficacy of a cooled bipolar epicardial radiofrequency ablation probe for creating transmural myocardial lesions. J Thorac Cardiovasc Surg. 2009;in press
  37. Lee AM, Aziz A, Sakamoto SI, Schuessler RB, Damiano RJ. Epicardial ablation on the beating heart: limited efficacy of a novel, cooled radiofrequency ablation device. Innovations. 2009;4:86–92
  38. Nakagawa H, Matsudaira K, Shah N, et al. Mapping along the entire atrial flutter ablation line is required to identify defects with markedly prolonged conduction times. PACE. 1999;22:844;(abstract)
  39. Prasad SM, Maniar HS, Diodato MD, Schuessler RB, Damiano RJ. Physiological consequences of bipolar radiofrequency energy on the atrial and pulmonary veins: a chronic animal study. Ann Thorac Surg. 2003;76:836–842
  40. Wolf RK, Schneeberger W, Osterday R, et al. Video-assisted bilateral pulmonary vein isolation and left atrial appendage exclusion for atrial fibrillation. J Thorac Cardiovasc Surg. 2005;130:797–802

 H. Nakagawa and W.M. Jackman are consultants for Biosense-Webster, Inc., and AtriCure, Inc. J.R. Edgerton and B.J. Scherlag are consultants for AtriCure, Inc.

 Ms. Lockwood, Dr. Peyton, Dr. Sivaram, Dr. Po, Dr. Beckman and Dr. Abedin have no conflicts of interest to disclose.

PII: S1547-5271(09)00997-7

doi: 10.1016/j.hrthm.2009.09.010

Heart Rhythm
Volume 6, Issue 12, Supplement , Pages S50-S63 , December 2009

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